Metabolic myopathy presenting with polyarteritis nodosa: a case report

<p>Abstract</p> <p>Introduction</p> <p>To the best of our knowledge, we describe for the first time a patient in whom an unusual metabolic myopathy was identified after failure to respond to curative therapy for a systemic vasculitis, polyarteritis nodosa. We hope this report will heighten awareness of common metabolic myopathies that may present later in life. It also speculates on the potential relationship between metabolic myopathy and systemic vasculitis.</p> <p>Case presentation</p> <p>A 78-year-old African-American woman with a two-year history of progressive fatigue and exercise intolerance presented to our facility with new skin lesions and profound muscle weakness. Skin and muscle biopsies demonstrated a medium-sized artery vasculitis consistent with polyarteritis nodosa. Biochemical studies of the muscle revealed diminished cytochrome C oxidase activity (0.78 μmol/minute/g tissue; normal range 1.03 to 3.83 μmol/minute/g tissue), elevated acid maltase activity (23.39 μmol/minute/g tissue; normal range 1.74 to 9.98 μmol/minute/g tissue) and elevated neutral maltase activity (35.89 μmol/minute/g tissue; normal range 4.35 to 16.03 μmol/minute/g tissue). Treatment for polyarteritis nodosa with prednisone and cyclophosphamide resulted in minimal symptomatic improvement. Additional management with a diet low in complex carbohydrates and ubiquinone, creatine, carnitine, folic acid, α-lipoic acid and ribose resulted in dramatic clinical improvement.</p> <p>Conclusions</p> <p>Our patient's initial symptoms of fatigue, exercise intolerance and progressive weakness were likely related to her complex metabolic myopathy involving both the mitochondrial respiratory chain and glycogen storage pathways. Management of our patient required treatment of both the polyarteritis nodosa as well as metabolic myopathy. Metabolic myopathies are common and should be considered in any patient with exercise intolerance. Metabolic myopathies may complicate the management of various disease states.</p

Minimum Cost Design of Irrigation Canals Using Probabilistic Global Search Lausanne

Cost-effective design of irrigation canals is essential for the planning and management of irrigation projects. In this study, the minimum cost design of irrigation canals is performed by considering the excavation cost, lining cost, cost for water losses and land acquisition cost. The complex non-linear and non-convex optimization model of irrigation canal design is solved using a recently developed meta-heuristic tool, namely probabilistic global search Lausanne (PGSL). The solutions are found to be competent with those reported based on classical procedures while applied for an example problem. To suit for real field applications, two site-specific constraints are added to the model for the optimal design of trapezoidal canals. The study shows the potential of the proposed PGSL approach to perform comprehensive design of irrigation canals

Shift in Indian summer monsoon onset during 1976/1977

The Indian summer monsoon rainfall (ISMR) contributes nearly 80% of the annual rainfall over India and has a significant influence on the country's gross domestic product through the agricultural sector. Onset of the ISMR displays substantial interannual variability and controls the crop calendar and hence the agricultural output. This variability is traditionally linked to sea surface temperature (SST) anomalies over the tropical Pacific Ocean. The tropical Pacific SST underwent a regime shift during 1976/77. Wereport a prominent delay in the Indian summer monsoon (ISM) onset following the regime shift. The onset dates are computed with the Hydrologic Onset and Withdrawal Index, based on vertically integrated moisture transport over the Arabian Sea (AS). The shift in onset is found to be due to the change in moisture availability over the AS. A delay in the development of easterly vertical shear reduces northward-propagating intraseasonal variability during May-June, limiting the moisture supply from the equatorial Indian Ocean (IO) to the AS. This, along with enhanced precipitation over the IO during the pre-monsoon, drives a reduction in moisture availability over the AS region from pre- to post-1976/77, delaying the ISM onset in recent decades. Our findings highlight the need for the re-assessment of the crop calendar in India, which is now based on the mean onset date computed from long-term data, without considering the regime shift or trends in onset

The influence of the El Nino Southern Oscillation on heat waves in India

The present study investigated the relationship between the El Nino Southern Oscillation (ENSO) and heat wave characteristics, such as duration, annual number of heat wave days and maximum temperature of heat wave events, in India. El Nino is associated with an eastward shift in the Walker circulation and breakdown of circulation patterns, resulting in delay in the onset of the Indian Summer Monsoon (ISM). Because most heat waves in India occur during the pre-monsoon season, the present study showed that heat waves during El Nino years were longer and hotter, and it is argued that this is related to a delay in the onset of the ISM. Further, it was found that the shift in the circulation pattern due to El Nino resulted in (1) the weakening of southwesterlies in the Arabian Sea, and (2) the occurrence of a large number of clear sky days over India. These explain the occurrence of warmer and longer duration heat waves during El Nino years. These results imply that, if El Nino activity increases in the future, heat waves in India are likely to intensify

Do dynamic regional models add value to the global model projections of Indian monsoon?

Dynamic Regional Climate Models (RCMs) work at fine resolution for a limited region and hence they are presumed to simulate regional climate better than General Circulation Models (GCMs). Simulations by RCMs are used for impacts assessment, often without any evaluation. There is a growing debate on the added value made by the regional models to the projections of GCMs specifically for the regions like, United States and Europe. Evaluation of RCMs for Indian Summer Monsoon Rainfall (ISMR) has been overlooked in literature, though there are few disjoint studies on Indian monsoon extremes and biases. Here we present a comprehensive study on the evaluations of RCMs for the ISMR with all its important characteristics such as northward and eastward propagation, onset, seasonal rainfall patterns, intra-seasonal oscillations, spatial variability and patterns of extremes. We evaluate nine regional simulations from Coordinated Regional Climate Downscaling Experiment and compare them with their host Coupled Model Intercomparison Project-5 GCM projections. We do not find any consistent improvement in the RCM simulations with respect to their host GCMs for any of the characteristics of Indian monsoon except the spatial variation. We also find that the simulations of the ISMR characteristics by a good number of RCMs, are worse than those of their host GCMs. No consistent added value is observed in the RCM simulations of changes in ISMR characteristics over recent periods, compared to past; though there are few exceptions. These results highlight the need for proper evaluation before utilizing regional models for impacts assessment and subsequent policy making for sustainable climate change adaptation